BACKGROUND/RATIONALE:
Mental illness has an enormous impact on health and productivity in the U.S. Twenty percent of Americans experience a mental disorder in the course of a year and 15% of the adult population receives mental health services. Within the Veterans Health Administration (VHA), 17.5% of VHA patients in FY 2001 received specialized VHA mental health services at a cost of almost $2 billion. High prevalence and cost have spurred interest in monitoring outcomes of mental health treatment, using a wide range of instruments and outcome assessment protocols. The VHA has mandated the use of a clinician-rated measure, the Global Assessment of Functioning scale (GAF) for mental health outcome assessment. However, the research literature suggests that the patient’s perspective should be incorporated into outcomes monitoring systems.
OBJECTIVE(S):
The objectives of the proposed study are to assess the incremental value of adding patient self-report measures to the GAF to: 1) compare the sensitivity to change (improvement over the course of mental health treatment) of three patient self-report measures to the (GAF); and 2) examine whether self-report measures provide extra explanatory power in predicting functional outcomes (employment, housing, social support, and psychiatric hospitalization). The three self-report measures selected for the study are the Veterans SF-36, Brief Symptom Inventory (BSI), and revised Behavior and Symptom Identification Scale (BASIS-R).
METHODS:
Primary and secondary data sources will be used. Primary data will include SF-36, BSI and BASIS-R assessments, self-reported race/ethnicity, employment status, housing arrangements and social support. Secondary data sources will be used to obtain demographic and diagnostic data, GAF ratings and psychiatric hospitalization after study enrollment. Data analyses will examine correlations between change in GAF ratings with change on each of the self-report measures, analysis of the Reliable Change Index to determine and compare meaningfulness of change on each measure, and multivariate logistic regressions to examine significance of change on self-report measures in predicting improvement in behavioral outcomes including employment status, housing, social support and hospitalization.
FINDINGS/RESULTS:
At this point in the study we have demonstrated the feasibility of our instruments and enrollment procedures. We have enrolled 1,083 individuals in the study (455 inpatients and 628 outpatients). Each completed the self-report assessment instruments at the time of enrollments. In addition, 312 inpatients and 339 outpatients completed Time 2 assessments. We have also begun the process of obtaining the administrative data needed for the study and merging it with the patient self-report assessments.
IMPACT:
This study will make three important contributions: First, it will provide valuable information comparing sensitivity of self-report measures with the GAF for measuring change over the course of treatment. This information will be useful for deciding whether to incorporate a patient self-report measure into mental health outcomes monitoring efforts within the VHA at either the program or system level. Second, it will provide information regarding the utility of obtaining baseline assessments of mental health status. Third, it will provide information that can guide decision-making regarding which of three widely used self-report measures is most sensitive to measuring change over the course of treatment.
PUBLICATIONS:
Journal Articles
- Clements KM, Murphy JM, Eisen SV, Normand SL. Comparison of self-report and clinician-rated measures of psychiatric symptoms and functioning in predicting 1-year hospital readmission. Administration and Policy in Mental Health. 2006; 33(5): 568-77.
